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Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: An analysis of 80 cases.

Symss NP, Ramamurthi R, Kapu R, Rao SM, Vasudevan MC, Pande A, Cugati G - Asian J Neurosurg (2014)

Bottom Line: With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease.With increasing experience, most of the complications are avoidable.The limited anterior callosotomy does not result in disconnection syndromes.

View Article: PubMed Central - PubMed

Affiliation: Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India.

ABSTRACT

Object: The objective of the present study is to analyze the complications and their avoidance in a series of 80 patients operated by transcallosal transforaminal approach to colloid cysts of the anterior third ventricle.

Materials and methods: The surgical outcome and complications of 80 patients operated by transcallosal transforaminal approach for colloid cysts in the anterior third ventricle was analyzed. A detailed pre- and post-operative neurological assessment was done in all patients. Neurocognitive assessment of corpus callosal function was done in the last 22 cases. CT scan of the brain was done in all patients, before and after surgery.

Results: All patients underwent transcallosal transforaminal approach. Total excision of the lesion was achieved in 79 patients and subtotal in one. The complications encountered were postoperative seizures in six, acute hydrocephalus in four, venous cortical infarct in four, transient hemiparesis in four, transient memory impairment, especially for immediate recall in nine, mutism in one, subdural hematoma in one, meningitis in three, and tension pneumocephalus in one patient. There were two mortalities. There was no incidence of postoperative disconnection syndrome.

Conclusion: Colloid cyst is surgically curable. With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease. With increasing experience, most of the complications are avoidable. The limited anterior callosotomy does not result in disconnection syndromes.

No MeSH data available.


Related in: MedlinePlus

Hypothalamic and other nuclei around the third ventricle and foramen of Munro
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Figure 4: Hypothalamic and other nuclei around the third ventricle and foramen of Munro

Mentions: Transient memory loss is probably due to forniceal manipulation during surgery and is not an unusual postoperative complication.[1624333435] Little and MacCarty reported no incidence of memory loss or personality changes following division of the anterior column of the fornix in patients with colloid cysts.[36] Memory deficits probably arise from direct and transmitted injury to deep midline and paramedian structures such as the basal forebrain nuclei, thalamic nuclei, septal nuclei, and inferior thalamic peduncle.[37383940] Some studies find little influence of one forniceal injury on recent memory if the contralateral fornix is intact.[41] The potential importance of the septal nuclei in memory function is underscored by the frequency of the amnesia in a patient who sustain rupture of the anterior communicating artery and subsequent damage to this region [Figure 4]. Hernesniemi and Leivo[32] have found that the far lateral corpus callosal incision has been especially valuable in avoiding memory disturbances. Jeeves et al.[42] found after careful testing that there is impairment in the transfer of the tactile data. However, Bogen[43] found that interhemispheric transfer of information is preserved as long as the splenium remained intact. Following forniceal lesion, it is observed that the remote memory is intact while there is loss of memory for recent events.[4044] Woolsey and Nelson have discussed about sectioning of the fornix bilaterally for the treatment of epilepsy without any incidence of memory loss.[41]


Complication avoidance in transcallosal transforaminal approach to colloid cysts of the anterior third ventriclen: An analysis of 80 cases.

Symss NP, Ramamurthi R, Kapu R, Rao SM, Vasudevan MC, Pande A, Cugati G - Asian J Neurosurg (2014)

Hypothalamic and other nuclei around the third ventricle and foramen of Munro
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129577&req=5

Figure 4: Hypothalamic and other nuclei around the third ventricle and foramen of Munro
Mentions: Transient memory loss is probably due to forniceal manipulation during surgery and is not an unusual postoperative complication.[1624333435] Little and MacCarty reported no incidence of memory loss or personality changes following division of the anterior column of the fornix in patients with colloid cysts.[36] Memory deficits probably arise from direct and transmitted injury to deep midline and paramedian structures such as the basal forebrain nuclei, thalamic nuclei, septal nuclei, and inferior thalamic peduncle.[37383940] Some studies find little influence of one forniceal injury on recent memory if the contralateral fornix is intact.[41] The potential importance of the septal nuclei in memory function is underscored by the frequency of the amnesia in a patient who sustain rupture of the anterior communicating artery and subsequent damage to this region [Figure 4]. Hernesniemi and Leivo[32] have found that the far lateral corpus callosal incision has been especially valuable in avoiding memory disturbances. Jeeves et al.[42] found after careful testing that there is impairment in the transfer of the tactile data. However, Bogen[43] found that interhemispheric transfer of information is preserved as long as the splenium remained intact. Following forniceal lesion, it is observed that the remote memory is intact while there is loss of memory for recent events.[4044] Woolsey and Nelson have discussed about sectioning of the fornix bilaterally for the treatment of epilepsy without any incidence of memory loss.[41]

Bottom Line: With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease.With increasing experience, most of the complications are avoidable.The limited anterior callosotomy does not result in disconnection syndromes.

View Article: PubMed Central - PubMed

Affiliation: Post Graduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, V.H.S. Hospital, Chennai, Tamil Nadu, India.

ABSTRACT

Object: The objective of the present study is to analyze the complications and their avoidance in a series of 80 patients operated by transcallosal transforaminal approach to colloid cysts of the anterior third ventricle.

Materials and methods: The surgical outcome and complications of 80 patients operated by transcallosal transforaminal approach for colloid cysts in the anterior third ventricle was analyzed. A detailed pre- and post-operative neurological assessment was done in all patients. Neurocognitive assessment of corpus callosal function was done in the last 22 cases. CT scan of the brain was done in all patients, before and after surgery.

Results: All patients underwent transcallosal transforaminal approach. Total excision of the lesion was achieved in 79 patients and subtotal in one. The complications encountered were postoperative seizures in six, acute hydrocephalus in four, venous cortical infarct in four, transient hemiparesis in four, transient memory impairment, especially for immediate recall in nine, mutism in one, subdural hematoma in one, meningitis in three, and tension pneumocephalus in one patient. There were two mortalities. There was no incidence of postoperative disconnection syndrome.

Conclusion: Colloid cyst is surgically curable. With good knowledge of the regional anatomy and meticulous microsurgical techniques, there is a low mortality and minimum morbidity, when compared to the natural history of the disease. With increasing experience, most of the complications are avoidable. The limited anterior callosotomy does not result in disconnection syndromes.

No MeSH data available.


Related in: MedlinePlus